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Стеноз желчных протоков при гепатолитиазе: характерные особенности и факторы риска резидуального холангиолитиаза

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Цель: определение факторов, влияющих на наличие остаточных камней после холедохоскопии и литотрипсии.Материал и методы. В нашем ретроспективном исследовании принял участие 201 пациент с гепатолитиазом и стенозом желчных протоков. С января 2018 г. по декабрь 2020 г. все пациенты перенесли холедохоскопическую литотрипсию с рассечением или без рассечения паренхимы и резекцией печени в отделении гепатобилиарной хирургии в больнице VietDuc University (Ханой, Вьетнам). Были собраны демографические данные, выявлены клинические особенности, получены результаты лабораторных исследований, установлен тип операции и особенности стеноза желчных протоков (локализация, число, степень выраженности). Основным критерием оценки была частота полного удаления камней в послеоперационном периоде.Результаты. У 82,6% пациентов был выявлен один участок стеноза, у 49,8% – несколько участков. Частота полного удаления камней после холедохоскопической литотрипсии составила 43,2%, а в сочетании с резекцией печени или рассечением паренхимы – 75,3%. Использование нескольких методов лечения и тип внутри печеночных камней являются двумя факторами, влияющими на наличие остаточных камней после операции.Заключение. Холедохоскопия является эффективным способом диагностики желчных камней и выявления особенностей желчных протоков. Резекция печени и рассечение паренхимы в сочетании с холедохоскопической литотрипсией представляют собой безопасный и эффективный метод лечения, повышающий частоту полного удаления камней при гепатолитиазе и стенозе желчных протоков. В осложненных случаях, связанных с внутрипеченочными камнями, необходимо комплексное и интенсивное лечение.

Ключевые слова:
желчные протоки, гепатолитиаз, стеноз, стриктура, холедохоскопия, литотрипсия, резекция печени, остаточный камень, hepatolithiasis, bile duct stenosis, choledochoscopic lithotripsy, hepatectomy, residual stone, predictors

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Bile duct stenosis in hepatolithiasis: a detailed characteristics and predictors for stone clearance

Our aim is to identify the prognostic factors for post-operative residual stone.Methods. Our retrospective study recruited 201 participants with hepatolithiasis and bile duct stenosis who underwent choledochoscopic lithotripsy with or without parenchyma incision and hepatic resection in Department of Hepatobiliary surgery, VietDuc University hospital, Hanoi, Vietnam from 1/2018 to 12/2020. Demographic information, clinical features, laboratory results, type of operation, bile duct stenosis characteristics (site, number, severity) were collected. Our primary endpoint was the post-operative stone clearance rate.Results. 82.6% had one stricture site, 49.8% had a severe stricture. The stone clearance rate after CEHL was 43.2, and combined hepatectomy/parenchymal incision was 75.3%. Multiple approaches and type of intrahepatic stone are two associated factors for residual stone.Conclusion. Choledoscopy is a valuable tool in finding gallstones and acquiring bile duct characteristics. Hepatectomy and parenchymal incision, along with choledoscopic lithotripsy, is a safe and effective method for increasing the clearance rate for hepatolithiasis and bile duct stricture. Comprehensive and aggressive treatment is needed in complicated intrahepatic stones.

Keywords:
желчные протоки, гепатолитиаз, стеноз, стриктура, холедохоскопия, литотрипсия, резекция печени, остаточный камень, hepatolithiasis, bile duct stenosis, choledochoscopic lithotripsy, hepatectomy, residual stone, predictors